Back

Accident Form

Accident forms are necessary for storing evidence of an incident which has taken place. They should be used in all workplaces but are also beneficial for schools, sport and activity clubs and at volunteering events.
Blackhorse Workshop
08/17/2022

Accident Form

18 steps
Accident forms are necessary for storing evidence of an incident which has taken place. They should be used in all workplaces but are also beneficial for schools, sport and activity clubs and at volunteering events.
  • Date

  • About the person who had the accident

  • Full name

  • Home address

  • Occupation (if they were at work, or their status (e.g bystander) if not at work

  • About you, the person filling in this book

  • Full name

  • Address

  • Occupation

  • Date

  • Your signature

    Click here to sign
  • About the accident (when it happened. Where it happened)

  • Date and time

  • In what room or place did the accident happen?

  • About the accident - what happened (say how the accident happened. Give the cause if you can. If any personal injury say what it is)

  • How did the accident happen?

  • What treatment has been given?

  • Employers statement (Record comments here. If the accident is reportable under RIDDOR, record the date and method used when first advising the relevant authority. Initial the box provided)

  • Reporting of Injuries, Diseases and Dangerous Occurrences, RIDDOR 2013

  • Method

  • Employers name and initials

  • Continue if required

Source: Blackhorse Workshop (Community Member)

Please note that any procedure, checklist, or other document available in the MaintainX Global Procedure Library is provided for general education and information only and does not constitute legal, medical, or financial advice. MaintainX makes the materials available AS IS and AS PROVIDED, without warranties of any kind. By downloading or using any such materials, you assume the risk that they may not be appropriate for your specific situation and agree that you are solely responsible for any such use, including compliance with applicable law and with meeting any conditions of product warranties.